中医药导报2024,Vol.30Issue(7) :71-76.DOI:10.13862/j.cn43-1446/r.2024.07.014

基于LASSO回归的心脏神经官能症刚虚证(肝肾阴亏、肝阳上亢证)关联因素筛选及诊断模型构建

Study on the State Identification Model of Cardiac Neurosis Patients with Rigid-Deficiency Symptom Based on LASSO Regression

王瑞婷 杨曜嘉 张慧 原晨 柳红良 李娅 王韵涵 赵鹏
中医药导报2024,Vol.30Issue(7) :71-76.DOI:10.13862/j.cn43-1446/r.2024.07.014

基于LASSO回归的心脏神经官能症刚虚证(肝肾阴亏、肝阳上亢证)关联因素筛选及诊断模型构建

Study on the State Identification Model of Cardiac Neurosis Patients with Rigid-Deficiency Symptom Based on LASSO Regression

王瑞婷 1杨曜嘉 1张慧 2原晨 3柳红良 4李娅 1王韵涵 1赵鹏5
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作者信息

  • 1. 北京中医药大学东直门医院,北京 100700
  • 2. 中国中医科学院广安门医院,北京 100053
  • 3. 北京中医医院顺义医院,北京 101399
  • 4. 航空总医院,北京 100012
  • 5. 北京中医药大学东直门医院,北京 100700;洛阳市中医院,河南 洛阳 471099
  • 折叠

摘要

目的:利用LASSO回归联合Nomogram构建心脏神经官能症刚虚证(肝肾阴亏、肝阳上亢证)的诊断模型.方法:采用单中心前瞻性研究,收集141例心脏神经官能症患者的临床资料,纳入分析变量包括年龄、民族、婚姻、教育程度、脑力/体力工作、体质量指数(BMI)、中医症状、中医五态人格量表各因子得分、汉密尔顿焦虑量表-14项、汉密尔顿抑郁量表-24项、症状自测评量表各因子均分.通过LASSO回归筛选与刚虚证诊断显著相关的影响因素,纳入二元多因素Logistic回归分析构建诊断模型,并对模型预测区分度及校准度评价,利用10重交叉验证进行内部验证,最后对模型进行Nomogram可视化,并根据ROC曲线确定诊断阈值.结果:共纳入刚虚证患者70例,非刚虚证患者71例.LASSO回归筛选出与刚虚证诊断相关性最显著的5个变量为女性、年龄、疲乏无力、善嗳气、五态人格中少阳积分.模型AUC为0.85,H-L检验为2.94(P=0.9824),提示模型区分度及校准度较好,10重交叉内部验证结果提示AUC为0.82.结论:LASS O回归联合Nomogram构建的诊断模型可协助诊断心脏神经官能症刚虚证,但研究结果的准确性尚待大样本临床研究进一步验证.

Abstract

Objective:To construct a diagnostic model for cardiac neurosis with rigid-deficiency symptoms using LASSO regression combined with Nomogram.Methods:A single-center prospective study was conducted to collect the clinical data of 141 patients with cardiac neurosis.Variables included in the analysis were age,ethnicity,marriage,education,mental/physical work,BMI,traditional Chinese medicine symptoms,and the scores of Chinese medicine five-state personality,the Hamilton Anxiety Inventory-14-item scale,the Hamilton Depression Inventory-24-item scale and the Symptom Checklist-90.The influencing factors significantly associated with the diagnosis of rigid-deficiency symptoms were screened by LASSO regression,incorporated into a binary multi-factor Logistic regression analysis to construct a diagnostic model,and the model was evaluated for predictive discrimination and calibration,internally validated using 10-fold cross-validation.Finally,the model was visualized by Nomogram,and the diagnostic threshold was determined according to the ROC curve.Results:A total of 70 patients with rigid deficiency syndrome and 71 patients with non-rigid deficiency syndrome were included.The LASSO regression screened the five most significant variables associated with the diagnosis of rigid-deficiency symptoms as female,age,fatigue,belching,and Shaoyang points in the five personality states.The model AUC was 0.85 and the H-L test was 2.94(P=0.982 4),suggesting good model differentiation and calibration,and the 10-fold cross-over internal validation results suggested an AUC of 0.82.Conclusion:In this study,the diagnostic model constructed by LASSO regression combined with Nomogram can help clinicians to rapidly diagnose patients with cardiac neurosis with rigid-deficiency symptoms,but the accuracy of the results needs to be further verified by large-sample clinical studies.

关键词

心脏神经官能症/刚虚证/刚柔辨证/临床诊断模型/LASSO回归/列线图

Key words

cardiac neurosis/rigid-deficiency symptom/rigid-gentle syndrome differentiation/clinical diagnostic model/LASSO regression/Nomogram

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基金项目

"十二五"国家科技支撑项目(2013BAI02B09)

河南省中医药科学研究专项课题(2023ZY2174)

北京市级中医药专家学术经验继承人(第六批)()

出版年

2024
中医药导报
湖南省中医药学会 湖南省中医管理局

中医药导报

CSTPCD
影响因子:0.952
ISSN:1672-951X
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